Medical management of preterm labor

Thanassas J, Koukoura Ο, Κoumantakis G, Sifakis S

Department of Obstetrics and Gynecology, University of Crete, Herakleio, Greece

Correspondence: Sifakis S, 228 Oulof Palme St, GR-71410 Herakleio, Crete, Greece




Preterm birth is the leading cause of infant mortality and morbidity. The rate of preterm birth has steadily increased over the past two decades, possibly associated with the increase of the use of assisted reproductive treatments and the limited effectiveness of tocolysis. Tocolytic agents may postpone preterm labor for a short time, enough for the action of corticosteroids and the transfer of the pregnant woman to a tertiary perinatal centre. In the current review, we present the mechanisms of action, the dosage, the pharmacokinetics, the clinical effectiveness, and the adverse effects of the various tocolytic agents that have been used in the clinical practice. We also shortly discuss the possible usefulness of the corticosteroids and the antibiotics in the treatment of the preterm labor and their perinatal consequences.

Key words: preterm labor; tocolysis; beta adrenergic agonists; magnesium sulfate; inhibitors of prostaglandin synthetase; nitric oxide donors; calcium channel blockers; antagonists of oxytocin receptors; progesterone; corticosteroids; maintenance tocolysis